冠状动脉内血动力学力量对动脉硬性斑块表型的影响
Alessandro Candreva1, Diego Gallo2, Daniel Munhoz3
1Department of Cardiology, Zurich University Hospital, Zurich, Switzerland; Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; PoliTo(BIO) Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy.
冠状动脉疾病的严重程度,通过压力梯度和壁切应力 (WSS) 来评估,与动脉样硬化斑块特征相关. 焦点疾病和高WSS与高风险斑块特征有关,为临床管理提供了信息.
科学领域:
- 心血管医学 心血管医学
- 生物医学工程 生物医学工程
- 干预心脏病学 干预心脏病学
背景情况:
- 冠状动力学显著影响动脉样硬化斑块的进展和不稳定.
- 了解压力梯度和壁切应力 (WSS) 之间的关系对于管理冠状动脉疾病 (CAD) 至关重要.
研究的目的:
- 调查焦点与分散的冠心内压力梯度和WSS模式之间的关联.
- 为了将这些血液动力学参数与慢性冠状动脉综合征患者的动脉硬性斑块组成相关联.
主要方法:
- 一项前性,国际,单臂研究,涉及血液动力学显著病变 (FFR ≤0.80) 的患者.
- 使用电机分流储备 (FFR) 拉回压度梯度 (PPG) 和光学连贯断层扫描 (OCT).
- 从3D血管学中导出时间平均WSS (TAWSS) 和拓剪切变化指数 (TSVI).
主要成果:
- TSVI与PPG有显著的相关性 (r=0.47,p<0.001).TSVI与PPG有显著的相关性 (r=0.47,p<0.001).
- 与扩散性疾病相比,焦点CAD (高PPG) 的TAWSS和TSVI显著更高.
- TSVI与斑块破裂 (OR 1.01),PPG与脂质延伸 (OR 7.78) 和薄盖纤维肌瘤 (OR 2.85) 相关.
结论:
- 由冠状动脉生理学定义的焦点和扩散CAD显示出不同的WSS配置文件.
- PPG和WSS模式与特定的动脉硬性斑块表型有关.
- 高PPG和TSVI表明焦点疾病,并与高风险斑块特征相关,有助于风险分层.
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